| NPI | 1619254042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301012029) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MI 630102029) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2017-03-14 |